MEDICARE: DR. BRADLEY G KRASNE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6620	KS

General Provider Information

NPI Number	:	1689745192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY G KRASNE DDS

Provider Business Mailing Address
First Line	:	500 MAIN PLACE
Second Line	:	SUITE 214
City	:	NEWTON
State	:	KS
Zip	:	67114-2211
Country	:	US
Telephone Number	:	316-283-8261
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 MAIN PLACE
Second Line	:	SUITE 214
City	:	NEWTON
State	:	KS
Zip	:	67114-2211
Country	:	US
Telephone Number	:	316-283-8261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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